發(fā)布時間：2018-08-18 12:31

【摘要】：背景：近年來膝關(guān)節(jié)前交叉韌帶(anterior cruciate ligament, ACL)損傷逐漸增多,而傳統(tǒng)療法并不能恢復(fù)其正常的解剖關(guān)系,長期以后可能導(dǎo)致膝關(guān)節(jié)不穩(wěn)、半月板損傷、關(guān)節(jié)軟骨磨損退變和繼發(fā)退行性關(guān)節(jié)炎等并發(fā)癥。ACL是膝關(guān)節(jié)中最重要的靜力穩(wěn)定結(jié)構(gòu)之一,兼有協(xié)助膝關(guān)節(jié)生理運動和限制非生理運動的雙重功能。鏡下重建ACL的技術(shù)日漸成熟,臨床上采用關(guān)節(jié)鏡手術(shù)治療ACL損傷的患者也越來越多。關(guān)節(jié)鏡下ACL重建術(shù)具有創(chuàng)傷小、手術(shù)時間短、可同時處理術(shù)中其它關(guān)節(jié)內(nèi)合并傷、定位準(zhǔn)確、術(shù)后功能恢復(fù)快以及并發(fā)癥少等優(yōu)點,目前被國內(nèi)外廣泛采用。膝關(guān)節(jié)前交叉韌帶重建的效果受諸多因素的影響,其中自體組織移植物和同種異體移植物在目前臨床上應(yīng)用最為廣泛。盡管近年來前交叉韌帶重建移植物的選擇以及術(shù)后療效的對比在國內(nèi)外已有大量研究,但至今尚無定論。目的：回顧性對比分析Endo-button系統(tǒng)關(guān)節(jié)鏡下分別應(yīng)用自體肌腱與同種異體肌腱重建膝關(guān)節(jié)前叉韌帶的近期臨床療效,為前交叉韌帶重建中韌帶重建材料的選擇提供臨床依據(jù)。方法：回顧性分析2012年5月至2014年5月于成都中醫(yī)藥大學(xué)附屬醫(yī)院我院骨科因ACLⅢ度損傷而行前交叉韌帶重建術(shù)的患者40例,其中A組自體肌腱組22例和B組同種異體肌腱組18例。A組選用自體胭繩肌肌腱,B組采用同種異體脛骨前肌腱,股骨端全部應(yīng)用Endo-button懸吊固定,脛骨端生物型擠壓螺釘和普通螺釘栓樁雙重固定。全部在術(shù)前及術(shù)后3個月、6個月、12個月記錄患者關(guān)節(jié)活動度、Lachman試驗結(jié)果,并進(jìn)行Lysholm、IDKC膝關(guān)節(jié)功能綜合評定。術(shù)后6個月、12個月復(fù)查患側(cè)膝關(guān)節(jié)X片及MRI。結(jié)果：兩組患者術(shù)后切口均為I／甲愈合,無感染及關(guān)節(jié)腔內(nèi)積血等并發(fā)癥發(fā)生。同種異體組患者均無明顯排異反應(yīng)。兩組患者均獲隨訪,隨訪時間12-18個月,平均13.5個月。術(shù)后12個月,前抽屜試驗、Lachman試驗、軸移試驗均為陰性。各組膝關(guān)節(jié)活動度、IKDC評分及Lysholm評分與術(shù)前比較,差異均有統(tǒng)計學(xué)意義(P0.05)各指標(biāo)兩組間比較差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論：ACLⅢ度損傷的患者膝關(guān)節(jié)的穩(wěn)定性已經(jīng)遭到嚴(yán)重?fù)p害,具有明確的手術(shù)指征。關(guān)節(jié)鏡下應(yīng)用Endobutton系統(tǒng)重建前交叉韌帶可以恢復(fù)膝關(guān)節(jié)的穩(wěn)定性及運動功能；自體胭繩肌肌腱和同種異體脛骨前肌肌腱在作為移植材料重建ACL時臨床療效確切,術(shù)后兩者對比分析近期臨床療效無明顯差異,自體肌腱在恢復(fù)膝關(guān)節(jié)本體感覺方面早期有優(yōu)勢,可以根據(jù)患者病情及手術(shù)醫(yī)生偏好選擇合適的重建材料。
[Abstract]:Background: in recent years, the (anterior cruciate ligament, ACL) injury of anterior cruciate ligament of the knee is increasing gradually, but the traditional therapy can not restore its normal anatomical relationship, which may lead to instability of the knee joint and meniscus injury in the long run. Articular cartilage wear and degeneration and secondary degenerative arthritis. ACL is one of the most important statically stable structures in the knee joint and has the dual functions of assisting the knee joint physiological movement and restricting the non-physiological movement. The technique of ACL reconstruction is becoming more and more mature, and more patients are treated with arthroscopy for ACL injury. Arthroscopic ACL reconstruction is widely used at home and abroad because of its advantages of less trauma, shorter operation time, more accurate positioning, faster functional recovery and fewer complications. The effect of anterior cruciate ligament reconstruction of knee joint is affected by many factors, among which autologous tissue grafts and allografts are most widely used in clinic. Although the choice of anterior cruciate ligament (ACL) graft reconstruction and the comparison of postoperative outcomes have been studied in recent years, there is no conclusion yet. Objective: to compare and analyze the recent clinical effects of arthroscopic reconstruction of anterior cruciate ligament (ACL) with autogenous tendon and allogeneic tendon under Endo-button system respectively, so as to provide clinical basis for the selection of reconstruction materials for ACL reconstruction. Methods: from May 2012 to May 2014, 40 patients underwent anterior cruciate ligament reconstruction in Department of Orthopaedics, affiliated Hospital of Chengdu University of traditional Chinese Medicine, who underwent anterior cruciate ligament reconstruction due to ACL grade 鈪，

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